| アブストラクト | AIMS: To compare long-term complications for people with type 2 diabetes mellitus (T2DM) following second-line treatment in routine practice with sulphonylureas (SU), dipeptidyl peptidase-4 inhibitors (DPP4i), or sodium-glucose co-transporter-2 inhibitors (SGLT2i) added to metformin. MATERIALS AND METHODS: We used the RAPIDS microsimulation model to predict diabetes complications over 5 years after second-line treatment initiation. We combined information on 'real-world' treatment duration in England from the Clinical Practice Research Datalink with evidence on treatment effectiveness from Randomised Controlled Trials (RCTs). We estimated between-treatment differences in the probabilities of end-stage kidney disease (ESKD), heart failure hospitalisation (HF), diabetic eye disease, myocardial infarction (MI), and lower-extremity amputation (LEA). RESULTS: The predicted probabilities of complications within 5 years were lower following second-line treatment with SGLT2i compared to SU and DPP4i. The mean (95% CI) difference (reduction) in the predicted probability of ESKD following SGLT2i versus SU was -0.81% (-0.89, -0.73), and for SGLT2i versus DPP4i the corresponding difference was -0.87% (-0.95, -0.79). The reduction in the probability of HF following SGLT2i versus SU was -0.90% (-1.01, -0.80), and for SGLT2i versus DPP4i it was -0.95% (-1.06, -0.84). The corresponding differences in the probabilities of diabetic eye disease following SGLT2i versus SU were -1.41% (-1.57, -1.26), and for SGLT2i versus DPP4i was -0.44% (-0.59, -0.29). The predicted probabilities of LEA were similar across treatments. Pre-existing CVD did not modify the predicted probabilities of complications. CONCLUSIONS: For a general T2DM population, second-line treatment with SGLT2i rather than SU or DPP4i can reduce the probability of complications within 5 years. |
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| ジャーナル名 | Diabetes, obesity & metabolism |
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| Pubmed追加日 | 2025/5/22 |
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| 投稿者 | Carroll, Orlagh U; Bidulka, Patrick; Basu, Anirban; Adler, Amanda I; O'Neill, Stephen; Briggs, Andrew H; Lugo-Palacios, David G; Khunti, Kamlesh; Grieve, Richard |
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| 組織名 | Department of Health Services Research and Policy, London School of Hygiene &;Tropical Medicine, London, UK.;Department of Non-Communicable Disease Epidemiology, London School of Hygiene &;The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute,;University of Washington School of Pharmacy, Seattle, Washington, USA.;Diabetes Trials Unit, The Oxford Centre for Diabetes, Endocrinology and;Metabolism, University of Oxford, OCDEM Building Churchill Hospital, Headington,;UK.;Diabetes Research Centre, University of Leicester, Leicester, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/40400097/ |
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